A Treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them, comprising the author's view of the physiology of the heart's action / by J. Hope.
- Hope, James, 1801-1841.
- Date:
- 1846
Licence: Public Domain Mark
Credit: A Treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them, comprising the author's view of the physiology of the heart's action / by J. Hope. Source: Wellcome Collection.
Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.
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![the chest are thinner. Thus, it is the most distinct in the emaciated, and in children; whereras, in very stout and muscular subjects, it may be barely perceptible. In hypertrophy with dilatation, the signs are a compound of those of hypertrophy and those of dilatation. The contraction of the ventricles can easily be felt by the hand applied to the precor- dial region, and we find, especially during palpitation, smart, vio- lent shocks, which strongly repel the hand. In extreme cases, I have known the extent of these almost equal that of the expended hand. If we attentively examine the patient when most calm, we see that not only his whole chest and the pit of the stomach, but his head, his limbs and even the bed-clothes, are strongly shaken at each contraction of the heart. The pulsations of the carotids, the radials, and the other superficial arteries, are often visible. The impulse of the heart can sometimes be distinctly felt as high as the clavicle on the left side of the thorax, and sometimes even on the left side of the back, especially in meagre subjects and children. [ The situation of the dulness on percussion, and of the impulse, will vary according to the form of the dilated hypertrophy and other circumstan- ces which affect the position of the organ. In elongated enlargement the-, impulse is generally felt helow its usual spot, between the fifth and sixth ribs, down to the seventh or eighth ; and I have even felt it in the abdomen, below the margin of the ribs. The dulness reaches from that part upwards, to the sternum. But constant, or even occasional distention of the abdomen, by any cause, which prevents the descent of the diaphragm, will make the enlarged heart take another position, by which its apex extends further to the left, and the dulness on percussion reaches from that point to the ster- num, occupying the whole intra-mammory and perhaps part of the mam- mary region. The same position of the heart, thus more horizontal than natural, may, perhaps, also be caused, as Dr. Hope has pointed out, by ad- hesion of the pericardium, which prevents the organ from enlarging down- wards. Enlargement of the liver, distention of the stomach or colon, and dropsical effusions in the abdomen are the most frequent causes of this lateral direction which enlargement of the heart often takes. Similar causes may also determine the displacement to be outwards, against the thoracic walls, occasioning them to project to the left of the sternum, in the manner described by Bouillaud. This is most remarkable in children, and in young persons with narrow chests. When the enlargement is more transverse or globular, the dulness on percussion, and the impulse, are higher, independently of the position of the diaphragm ; and this is particularly the case when the right ventricle is also enlarged.—C. J. B. Williams.—P.] In hypertrophy with a predominance of dilatation, the impulse- is ordinarily not considerable; but it becomes very marked during palpitation, especially if accompanied with fever, and it has a very different character from that occasioned by simple hypertrophy. The beats, as well described by Laennec, are strong, hard, and produce a shock analogous to the blow of a hammer; but the blow seems to strike a small space, it expends itself, as it were, on the thoracic parietes, and does not communicate to the head a heaving proportioned to its force: it differs, in short, from the impulse occa- sioned by great hypertrophy, in the circumstance that, in the latter, the ventricles in a distended state, seem to heave with their whole](https://iiif.wellcomecollection.org/image/b21036937_0280.jp2/full/800%2C/0/default.jpg)
